Article: Better disability screening can lessen disparities

People with disabilities have greater risk for experiencing healthcare disparities and differences in diagnoses, treatments and outcomes, according to new research.

The findings were published in a CE article in the April/May issue of the Journal of Healthcare Quality, the peer-reviewed publication of the National Association for Healthcare Quality.

Nearly 20% of the U.S. population lives with a disability, but little attention has been paid to improving the quality of healthcare provided to these patients. A major factor has been inadequate identification of specific disabilities, according to the researchers.

“People with disabilities are a diverse population and it is difficult to fully capture their experiences within the healthcare system,” lead author Megan A. Morris, PhD, MPH, said in a news release. Morris completed the study while a postdoctoral research fellow at the Center for Healthcare Studies at Northwestern University, Chicago.

“After passage of the Affordable Care Act, the Department of Health and Human Services published six required disability status questions, but they fulfill agency needs and are not designed to gather disability data within a healthcare provider organization,” she said in the release.

According to Morris, the questions, which are derived from the American Community Survey, may be limited because they focus on impairments and limitations and do not include environmental and personal factors.

“For example, two people with difficulty bathing (limitations) could have significantly different disability experiences based on the presence of an accessible bathroom at home (environmental factors),” Morris and her co-authors wrote. “These two people, while having the same limitation, have very different environments that greatly affect their disability, and potentially their health.”

The ACS questions also do not address communication or learning disabilities, the authors wrote, even though patients with those disabilities are important to identify because they might have difficulty in communicating with physicians or with overall health literacy.

The article recommends further research to develop questions that capture the range of possible disabilities, levels of severity and whether patients use assistive devices. The authors note these questions could produce data healthcare organizations can use to develop quality improvement initiatives.

The authors suggest researchers include people with disabilities and their families in developing questions, which would help incorporate a broader perspective that considers environmental and social factors. Because a patient’s level of disability can change with time, the researchers also call for research to determine how frequently to ask questions to gain the best data.